Brandon House

Brandon House is a 'care home' which provides accommodation and personal care for up to 42 older people some of whom may be living with dementia. At the time of the inspection there were 27 people using the service.

People’s experience of using this service and what we found

People felt safe. People received medicines safely and on time, however medicine documentation was not robust. Incidents and accidents were recorded and there was evidence of appropriate action taken however the service did not monitor themes and trends.

We observed some staff not wearing masks correctly during our inspection. This was raised during the inspection and the provider agreed to take immediate action. There were enough staff employed to ensure people's needs were being met. We observed staff responding to people's needs in a timely manner and staff presence in communal areas. Staff were recruited safely. The provider had recruitment checks in place to ensure staff were suitable to work in a care setting, however recruitment documentation was not clear.

The home did not have a registered manager. The regional manager was providing additional support whilst the service was in the process of recruiting a manager. The lack of a registered manager had impacted the service negatively. Since the previous registered manager left staff had not received regular supervision and the service did not hold regular meetings. Feedback from staff and relatives about the management was mixed, however all staff and relatives we asked stated they noticed a negative change in the service without a manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The last rating for this service was requires improvement (published 10 November 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe section of this full report. You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brandon House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Brandon House is a care home providing personal care to people aged 65 and over, some of whom are living with dementia. At the time of the inspection there was 35 people using the service. The service can support up to 42 people. The home provides single room accommodation with most rooms having en-suite facilities.

People’s experience of using this service and what we found

We found staff without the correct employment checks therefore we could not be assured the recruitment process was safe and effective.

There were various activities organised for people focused on their needs and preferences.

People told us they felt safe living at Brandon House. The provider had effective safeguarding systems in place. Staff demonstrated a good understanding of how to raise safeguarding concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last inspection was rated requires improvement and there were no breaches (published 11 August 2020).

Why we inspected

This was a planned inspection and was prompted in part by the services history of inadequate ratings and previous breaches. This inspection examined those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brandon House on our website at www.cqc.org.uk

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence the provider needs to make improvements. Please see the Safe and Well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified a breach in relation to the recruitment process at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Brandon House provides nursing and personal care for a maximum of 42 older people, some of whom are living with dementia. At the time of our inspection there were 15 people living at the service. The home provides single room accommodation with most rooms having en-suite facilities.

People’s experience of using this service and what we found

Improvements had been made following the previous inspection in July 2019. People and their relatives told us they or their family members felt safe and well supported at the service. People were protected from abuse and avoidable harm and were treated with respect and dignity.

Overall, the provider maintained safe staffing levels to meet people’s needs. We have made a recommendation that the provider continues to monitor sufficiency of staffing. Risks to people’s health and safety were managed well, although some improvements on the completion of records to monitor people’s fluid intake were needed. Improvements had been made to medicines management with clear records showing people received their medicines and topical creams as prescribed.

The registered manager and staff promoted and encouraged person centred care to ensure people were treated as individuals. They knew how people preferred to receive their care and support. This included activities, which had been tailored to try and meet people’s needs in the current circumstances of the Covid-19 pandemic.

There was positive leadership in the service. People, their relatives and staff spoke highly of the registered manager. They were described as approachable. Improvements had been made to governance systems. Audits and monitoring procedures were used effectively to monitor the service and to make improvements. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 27 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 27 August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out a comprehensive inspection of this service on 15 and 18 July 2019. Breaches of legal requirements were found.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which refer to those requirements.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brandon House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Brandon House is a nursing home situated in the Meanwood area of Leeds and provides accommodation for up to 42 older people. The home provides single room accommodation with most rooms having en-suite facilities. The building provides wheelchair access throughout, with private grounds and parking facilities.

People’s experience of using this service and what we found

People did not always receive a service that provided them with safe, effective and high-quality care. Risk management was not always effective. Some infection control practices were ineffective and potentially placed people at risk of harm. The management of people’s medicines was not fully safe. Areas of the home looked tired and did not fully provide a dementia friendly environment.

Care plans were not always consistent, and some agency staff were not fully aware of people’s needs. Governance arrangements were not robust. Audits undertaken had not always identified where improvements were needed so appropriate action could be taken. For example, in relation to the environmental and hygiene standards. People’s records were not kept securely.

Staffing numbers were insufficient to ensure people received safe and timely support. Even though staff were caring in their approach, staff were task focused in their interactions with people. People’s dignity was not always respected. Activities were limited and did not meet the needs of people who used the service. People’s nutritional, hydrational and healthcare needs were not always met.

Staff understood how to identify and report any safeguarding concerns. Recruitment procedures were followed. Staff had received an induction, had completed mandatory training and supervision was conducted. However, appraisals had not been completed prior to these being started in June 2019.

People said they were happy with the service provided. People and relatives had the opportunity to provide feedback on the service received and there was a system to respond to complaints.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s end of life care needs were met.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was Good (published 19 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement: We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 namely safe care and treatment, dignity, person-centre care, staffing and good governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Brandon House is a nursing home and provides accommodation for up to 42 older people. The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service and their relatives told us the service was safe. Staff had received training to help them understand how to keep people safe. The home looked well maintained, clean and tidy, and checks were carried out to make sure the premises and equipment was safe.

There were sufficient staff with the right skills and experience; several staff told us the staffing arrangements had improved. Appropriate checks were carried out before staff were employed. Medicines were managed safely.

People who used the service and their relatives told us they were happy with the staff who provided care and support. Staff we spoke with said they felt well supported and received training that made sure they knew how to do their job well. They said they understood their role and responsibilities. The registered manager was going to review the induction arrangements to ensure they met recognised guidance. Staff we spoke with understood their responsibilities around how they should support people with decision making. People had good meal experiences, enjoyed the food, and had plenty to eat and drink. Systems were in place that ensured people accessed healthcare services.

People told us they were well cared for and visiting relatives told us the service was caring. We observed care workers supported people in a calm, compassionate and caring way. Staff were cheerful and friendly. When they walked by people they would say “hello” and checked they were ok. When staff assisted people to move and transfer they explained what was happening and reassured them throughout. Staff knew people well, for example, what people liked to do and their family members. We saw one situation where staff were not responsive to a request for support.

People had access to information which kept them informed.

Staff responded to people’s individual needs and delivered personalised care. People’s care plans and other records showed their needs had been assessed and care was usually planned, although there was inconsistency with the level of detail and we saw examples where care plans had not been followed. Action was being taken to improve activities.

The service had developed a 1950's village around the back of the nursing home which people could access. People told us they would talk to staff and management if they had any concerns and complaints had been responded to in a way which resolved the issue where possible to the person’s satisfaction. Several written compliments had been received.

We received positive feedback from people about the registered manager. Several relatives described them as “welcoming” and several staff described them as “supportive”. Resident and relative meetings and staff meetings were held. We saw from meeting minutes that people had opportunity to discuss the service and were informed of planned events. Where people had made suggestions for improvement the provider had responded. At the inspection we reviewed a wide range of audits which had been completed at the service, which were then used to monitor the quality and safety of service delivery.

Is the service safe?

The home did not have policies in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The policies the home did have in place had not been dated nor did they have a review date. The service had not taken steps to ensure practice was updated through the review of policies. The home was not compliant with DoLS.

The safeguarding policy was followed correctly by staff and all staff received training in this area.

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care records and risk assessments were in place. The care records we looked at were generic and were not person-centred. We saw examples of incorrect information in the care records we looked at. This meant people were at risk of receiving inappropriate care and support.

There was no evidence to show that incidents had been analysed and lessons learnt from any accidents or incidents. This meant the service was not able to identify risks to people and to develop plans to reduce the risks.

In one of the bathrooms we looked at we saw the toilet seat was soiled. In another bathroom, the door wouldn't close securely and the toilet seat was broken. The interior of the service was in the process of being refurbished and there was a lot of dust in one of the rooms on the dementia unit. Some of the carpeted floors looked dirty and the hardwood floors felt sticky underfoot. The paint on some of the doors and skirting boards had chipped. There was a risk that the chipped areas could harbour germs that could put people's health at risk.

Is the service effective?

There was no evidence to show people's health and care needs were assessed with them. In the care records we looked at we could find no evidence to show people had been involved in decisions relating to their care. This mean that there was a risk staff were not able to deliver care in a way that supported people because the service had not taken steps to ensure people had been involved in their care planning.

Although visitors we spoke with told us they felt staff cared for their relatives and friends very well, in the training matrix we looked at we saw less than 50% of staff had attended training on key areas such as moving and handling, fire safety, health and safety and Mental Capacity Act 2005. Staff had not been enabled to take part in learning and development that was relevant and appropriate to their role.

Is the service caring?

We found people were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We observed people looking well dressed.

Staff had a good relationship with people who used the service and it was clear care staff were committed to their role.

During the inspection we observed the call bells were not answered promptly. In some of the rooms we visited we saw that call bells had been placed out of people's reach. We spoke to one person about this, they told us their bell was always slipping off their bed.

Is the service responsive?

The service carried out annual reviews of the service which included people who used the service and their relatives/friends. The service did not routinely include external agencies in their review. The service did not have a plan of how they would involve people who had difficulty communicating. This meant people were not included in the review of the service and were not given the opportunity to express their views.

The service had held a residents and relatives meeting in the past but we could not see that a meeting had been held recently. The visitors and relatives we spoke with told us they felt the manager listened to their concerns and acted on them.

The service employed an activities coordinator and they told us about the range of activities on offer. On the day of inspection, we saw that none of the people on the dementia unit had been included in the activity planned for that day.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The care staff confirmed the manager was very supportive. Staff meetings were held so that people could air their views. Staff felt they had been listened to by the manager.

We could see no evidence care staff were offered formal supervision and there was no record of them having had an annual appraisal. The manager told us they did not feel supported by their line manager. They had not received supervision and had not received an annual appraisal.

We saw the communal areas and the bedrooms were clean and free of any malodours. A person who used the service said, "It's always clean, someone is always cleaning." There were effective systems in place to reduce the risk and spread of infection.

During the visit we observed staff supporting people and saw that staff responded promptly to any requests for assistance. Staff told us the staffing levels were sufficient to meet people's needs.

A staff member said, "We try and make Brandon House a friendly place to live in, after all it is their home."

received.

People said, 'I'm very well looked after here. If I need help during the night, they (staff) come and help me straight away'. 'The staff are marvellous, each and every one of them'.

One relative told us that they, 'Always turned up at any time and we don't have to stick to visiting hours'. They told us that they were totally confident that staff cared for their relative well. They stated they found the care their relative received was, 'Consistent' and that, 'Their nails are always clean and their hair is always brushed'. They said they thought that all the staff were, 'Honest and accommodating' with them.

People told us that there were always plenty of staff on duty and they felt able to approach staff when they wanted to. Both relatives we spoke with told us that they felt that staff listened to them. They told us that they felt involved in decisions regarding their relatives care.

One person told us that,' They (staff) always treat me with great respect'.

A relative told us that their relative 'Had improved a lot since being here, they have started to feed themselves and they don't need their food liquidising anymore'.